Financial Hardship Program -

Footprints to Recovery’s Financial Hardship Program is designed to reduce patient costs for eligible patients with limited financial means. Footprints to Recovery offers the Financial Hardship Program to individuals who are unable to pay in full for services.

The company will not discriminate on the basis of ethnic group identification, religion, age, sex, color, gender, race, sexual orientation, or disability. Company’s sliding scale fee schedule is based on the Federal Poverty Guidelines.

To be considered for the Financial Hardship Program please fill out the below application in full. Upon receiving your application Footprints to Recovery’s financial specialists will review your information and contact you with further steps.

If you have any questions along the way, feel free to contact us.

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Financial Hardship Program

Please complete the following information to help us determine if you or members of your family are eligible for a percentage cost reduction. The percentage cost reduction will apply to all services received at this facility, but not to those services received outside the facility. This form must be completed every 12 months or if your financial situation changes.

Financial Hardship Program Application

"*" indicates required fields

Patient

Patient's Name (First/Last)*

Facility Location*

Account Number (If Applicable)

Head of Household

Head of Household Name (First/Last)*

Email*

Invoice Number (If Applicable)

Street*

City*

State*

Zip Code*

Phone*

Please list self, spouse and dependents under age 18.

Relationship*

Last Name*

First Name*

Date of Birth*

Relationship

First Name

Last Name

Date of Birth

Relationship

First Name

Last Name

Date of Birth

Relationship

First Name

Last Name

Date of Birth

Relationship

First Name

Last Name

Date of Birth

Relationship

First Name

Last Name

Date of Birth

Relationship

First Name

Last Name

Date of Birth

Relationship

First Name

Last Name

Date of Birth

Total Household Size (Number of Individuals Living in House)

Other*

Final Total*

NOTE: Please include copies of tax returns, W2s, pay stubs, or any other information verifying income.

Please provide any additional notes on your circumstances:

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First Name*

Last Name*

I certify that the family size and income information shown above is correct.

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Payment Options For Footprints To Recovery

The cost of addiction treatment is among the top concerns for individuals and families when considering treatment. Our trained, experienced, and knowledgeable admissions coordinators work alongside our team of financial advisors to help you determine the best financial plan.

Paying With Insurance

Your insurance may cover a portion of the bulk of treatment costs, which vary from person to person and depend on your specific policy. Footprints to Recovery accepts most major insurances and will work directly with your provider to get you the best coverage.

Private Pay Options

For those who would rather not use their insurance or are only approved for coverage of a portion of treatment, we accept private pay at any of our facilities.

We offer flexible payment plan options if needed.

Apply For Financing

No insurance? Private pay not an option? We’ve partnered with Prosper Healthcare to provide flexible, affordable loan solutions designed specifically to cover treatment costs. With Prosper Healthcare, you can easily apply for full or partial financing, helping you access the care you need without the financial strain.

Apply For a Scholarship

We’re committed to more than just providing treatment to those who can afford it. Our treatment scholarship provides addiction rehabilitation services to individuals unable to pay for care. For scholarship eligibility, reach out to one of our admissions coordinators today.